Abstract

Objective To determine if the addition of preventive drug treatment (β blocker), brief behavioural migraine management, or their combination improves the outcome of optimised acute treatment in the management of frequent migraine.

Design Randomised placebo controlled trial over 16 months from July 2001 to November 2005.

Setting Two outpatient sites in Ohio, USA.

Participants 232 adults (mean age 38 years; 79% female) with diagnosis of migraine with or without aura according to International Headache Society classification of headache disorders criteria, who recorded at least three migraines with disability per 30 days (mean 5.5 migraines/30 days), during an optimised run-in of acute treatment.

Contributors: KAH, CKC, FJO’D, and GEC were responsible for the study concept and design. KAH, BWC, and FJO’D obtained funding. KAH, CKC, FJO’D, GEC, and JBD were involved in acquisition of data. KAH, BWC, and LH analysed and interpreted the data. LH, BWC, and KAH did the statistical analysis. Victor Heh assisted with data analysis. Jenifer Labus did the computerised randomisation. KAH drafted the manuscript, and all authors critically revised it for important intellectual content. KAH, CKC, FJO’D, and JBD provided administrative, technical, or material support. KAH, CKC, and JBD supervised the study. KAH is the guarantor.

Funding: Grant R01-NS-32374 (awarded to KAH) from the National Institutes of Health provided primary support for this trial. Merck Pharmaceuticals and GlaxoSmithKline Pharmaceuticals donated triptans for the trial, which was their only involvement. These organisations had no role in the data collection, statistical analysis, or writing of this article or the decision to submit for publication.

Competing interests: KAH has consulted for ENDO Pharmaceuticals and for Takeda Pharmaceuticals North America and received an investigator initiated grant from ENDO Pharmaceuticals. He has also received support from the National Institutes of Health (NINDS; NS32375). CKC has received research funding and materials from GlaxoSmithKline Pharmaceuticals (GSK) and Merck and participates in industry sponsored research involving GSK, Merck, UCB Pharma, and Allergan. FJO’D has received research funding and materials from GSK and Merck; receives educational funding from GSK, Merck, and Allergan; participates in industry sponsored research involving GSK, Merck, UCB Pharma, and Allergan; and has consulted for and received honorariums from GSK. GEC owns stock in Johnson and Johnson, Novartis, and Wyeth Pharmaceuticals.

Ethical approval: All participants provided written informed consent according to procedures approved by the Ohio University Human Subjects Committee.

Data sharing: Technical appendix with statistical code and details of analyses available from the corresponding author at (holroyd{at}ohio.edu) or biostatistician (himawan{at}ohio.edu). Consent was not obtained from participants, but risk of identification is low.